Claim by Ken HansonCity of Dubuque Consent Items # 2.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUMMARY:
SUGGESTED
DISPOSITION:
ATTACHMENTS:
Description
Copyrighted
August 16, 2021
Ken Hanson for vehicle damage; Luke Morarend for vehicle damage;
John Sweeney for property damage.
Suggested Disposition: Receive and File; Refer to City Attorney
Claim by Ken Hanson
Claim by Luke Morarend
Claim by Sweeney Properties / John Sweeney
Type
Supporting Documentation
Supporting Documentation
Supporting Documentation
Confidential
This communication and any attachments may contain information which is confidential
and privileged by law and is for t
intended recipient, you are hereby
error, and that any review, disclosu
is prohibited. Please notify City of
your receipt of these items an(
immediately. Further disclosure
restrictions.
ie use of the designated recipient. If you are not the
notified that you have received this communication in
e, dissemination, distribution or copying of its contents
)ubuque immediately by telephone at (563)-589-4120 of
destroy the communication and any attachments
of this information may violate state and federal
Confidential information may include the following:
1) Social Security Number(s)
2) Medical/Health Information
3) Personnel/Disciplinary Information
4) Bank Account Information
5) Financial Information
6) Credit Card Numbers
If any documentation you desire to submit to the City of Dubuque contains any of the items above
this cover sheet must be attached directly to the confidential information and indicate the type of
information that is included.
hereby certify that the attached documents
include the following protected information:
Social Security Number(s) Bank Account Information
Medical/Health Information Financial Information
Personnel/Disciplinary Information Credit Card Number(s)
I understand that this information may be distributed within the City organization or to agents of the
City for processing and I hereby authorize the City to act accordingly taking all precautions to
protect my information from unnecessary distribution.
4
Signature Dafe
CL,�
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA 6 I CC>
This written report constitutes your claim against the City of Dubuque, Iowa. You should
complete this form In full and attach any additional information that supports your claim.
The Claim must be filed with the City Clerk at City Hall, 50 W. 131 St., Dubuque, IA 52001. It
will then be referred by the City Council to the appropriate department for investigation.
Once that investigation is completed, a report and recommendation will be submitted to the
City Council. You will be provided with a copy of that report and recommendation.
THE FINAL DECISION ON ALL CLAIMS IS MADE BY THE CITY COUNCIL. NO EMPLOYEE OF
THE CITY OF DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO YOU
AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
1. Name of Claimant:
2. Address:
City: U:v, 1 State:I� wa Zip:
3. Telephone Number: C3!`/� �(O - 7c%�
4. Date of Incident:
5. Time of Incident: �a'z
6. Location of Incident (Be specific):-�% u'es� , I �s� P25/
e
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give
full details upon which you base your claim. If a City employee was involved, give the
employee's name.)
/ II I
�i vK,5t2�c. T )?el,eve- new 1-<"6 W25 -f-�.e One who rha�ly G � 7
8. What were weather conditions like? G[BZP o�ry ! n�g/� rho
9. Give name and address of any witnesses: �Z11/ WVa .912,1C4UJv1 CJrco ` to
10. Did police investigate? (If so, give names of officers.)
Dzlc- Lois
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
rD
12. Was any damage done to property? (If so, describe property and the extent of
damages. Attach estimates of damages or describe basis for ascertaining extent of
damage.) I / 1
-f t,e3 , o n L wAe% , -7L Cw Kee // pL,f,'O / )'T J r-3.1-0 Ae— /.
13. What other damages do you claim, if any? I7OnC-
14. Have you been compensated for any part or all of your claim by any insurance
company? (If so, give name and address of insurance company and amount paid.)
/t/o
15. What amount do you claim from the City of Dubuque? c 3 ,
16. Why do -4you claim the City of Dub/U q a is responsible? II 1 II
l#Or i }cer jJ. I. ?^d Ml one,:�- g%e-- ScGnG � wo#A'd Le feltMPV
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
Dated at Dubuque, Iowa this 91h day of 200
nt Name)
(Rev. 5118)
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app.towbook.com/,f"..',
Barrie D.U& `: VeMda Summary
InMe:a4 71-1A545 YIN N—t— 1FT41M'39F31FR75fiR7
Cail # 14545 Model: 2001 Ford F-350 Soper Doty
Al.—M CASH(PRIVATE RETAIL CUSTOMER Donee Plate HANSN34 (IA)
Da/R/lima!Nt NtMtM'/n4rAly1 �^.11:777 AM Vn-bin' Nrt
Da1e(Tkne Compieted:7/19l2021 gt4:34AM
Customer. Ken Firi—, 319-560-9R66).
Tow From: Hwy 20 and freshest lake
Tow To: 613 wed 4th vin", Iowa -
Charges Summary
S—i" Man
Loaded/Hooked Mileage
Flatued Tow (After-hours)
Deadhead (Retum Miles)
i. Credit Card Fee
s!gnawrc:
4/0ty Price
tine Tout
tz50
C22500 -
'85.00
$S5.00
C20t1
$1S0.00 ..
tt a'72
$15.72:
Subtotal
a.505 72 .
Taaa
$34 30
Gfartd Total
$5,60.02
Visa payment of $540.02 applied
USW: 2306347
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3
MENU
eBay -$565.00
=- July 21, 2021
Payment Sent - PayPal Credit
Paid with
PayPal Credit $565.00
on July 21, 2021
Ship to
Anton Sales Attn: Ken
1116 W 5th St
Vinton, IA 52349-1130
United States
Transaction ID
lA003673EC577304M
Seller info
eBay
866-540-3229
http://eBay.com/help
https://eBay.com/help
Invoice ID
v2 4d81b2d3-7742-46f1-aa33-20f56e0d33c4 2 20
Note
Order Number: 16-07368-90328
Purchase details
Purchase amount $565.00
Total $565.00
Need help?
If there's a problem, make sure to contact the seller through PayPal by January 17, 2022.
WAYNE'S REPAIR
613 WEST 4th ST., VINTON, IOWA 52349
11/z% PER MONTH FINANCCf4CHARGE OWILL BE ADDED TO ALL
PAST DUE ACCOUNTS, ANNUAL PERCENTAGE RATE WILL BE 18%
a iUiuniea goons MU61 be accompanied by this bill.
34504 `7mnk`You
SAM'S
VINTAGE FORD PARTS, INC.
5105 Washington Street • Denver, Colorado 80216
303-295-1709
SPECIALIZING IN NEW FORD PARTS FOR OLDER MODEL CARS AND TRUCKS
(32-70)
SOLD TO ,`1 ' _ '/ ere -1 LZ )
ADDRESS
CITY c STATE ZIP _
CASH CHARGE C.O.D. CREDIT SHIPPED VIA
QUAN
PART NO.
ARTICLE
PRICE
AMOUNT
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REC'D BY TAX
TOTAL
PLEASE PAY THIS INVOICE
NO STATEMENT WILL BE SENT UNLESS REQUESTED
NO RETURNS AFTER 10 DAYS
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City of Dubuque
City Council Meeting
Consent Items # 3.
Copyrighted
August 16, 2021
ITEM TITLE: Disposition of Claims
SUMMARY: City Attorney advising that the following claims have been referred to
Public Entity Risk Services of Iowa, the agent for the Iowa Communities
Assurance Pool: Masud Hamid for personal injury; Ken Hanson for
vehicle damage; Luke Morarend for vehicle damage; John Sweeney for
property damage.
SUGGESTED Suggested Disposition: Receive and File; Concur
DISPOSITION:
ATTACHMENTS:
Description
I CAP Referral
Type
Supporting Documentation
THE CITY OF
DUB E N N D H a
Masterpiece on the Mississippi
JONI MEDINGER
LEGAL ADMINISTRATIVE ASSISTANT
To: Mayor Roy D. Buol and
Members of the City Council
DATE: 8/11 /2021
RE: Claim Against the City of Dubuque by Ken Hanson
Claimant Date of Claim Date of Incident Nature of Claim
Ken Hanson 8/9/2021 7/19/2021 Vehicle Damage
This is a claim in which claimant alleges claimant's vehicle was damaged due to use of a
spike strip by City of Dubuque Police Department personnel.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
Mark Dalsing, Chief of Police
Ken Hanson
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563) 589-4113 / FAX (563) 583-1040 / EMAIL jmedinge@cityofdubuque.org